What Is Integrated Therapy?

by Judy Hazelgrove

Integrated therapy, like traditional therapy, is governed by the guidelines and policies of the related services professions. Also like traditional therapy, integrated therapy includes various levels of support and degrees of service. Related services accommodate, modify, compensate for, and reduce effects of a disability so a student can participate and benefit from the special education program. As in traditional therapy, goals are written based on individual student needs.

So how is it different? In integrated therapy, a student's related service needs are planned, provided, and assessed ecologically, in natural settings, across disciplines. Skills are found and thus addressed in the clusters which serve functions in a student's real life. The IEP is collaboratively written and priority skills are determined for student participation, functional independence, and overall benefit from the educational program.

Service Delivery

Integrated therapy can include direct (therapist works with a student), indirect (therapist works with a class or group including a student), and consultation-style (therapist meets with teacher(s) of a student) therapy. However there is usually an increase in indirect therapy and consultation with a decrease in direct therapy sessions occurring in isolation, or "down the hall in the therapy room." The teacher, therapist, and paraprofessional work and learn together, sharing their knowledge and expertise. They work to serve the student in a "whole" fashion focusing in on parts as they relate specifically to the student's total school program. The teacher gains an understanding of therapy techniques and strategies to follow-through the entire school day. The therapist gains understanding of the inter-relatedness of the needed supports or skills with the complete scope and sequence of the educational curriculum.

The integrated therapy occurs in various locations based on the relevant or natural setting for the skill to occur. If there is a need for service in isolation because of privacy or distraction issues, it can be provided. If service needs to occur in a social setting or be integrated into coursework, then the instruction, assessment, and service is completed in that location. For example:

  • The Physical Therapist (PT) works during a general education PE class to assist with accessibility ideas for games.

  • The therapist assists during math, designing and trying a menu of accommodations needed for Lonnie's handwriting difficulties.

  • The Occupational Therapist (OT) assists in art class with modifications needed for Mario to use a paintbrush and scissors effectively.

  • The Speech/Language Pathologist (SLP) works during language arts within the general education class to assist with augmentative communication devices.

The PT, OT, and SLP alternate accompanying Ms. Nygun's students on their community trips to the mall.

The number, frequency, and length of integrated therapy sessions can be flexible based on changes in the student's needs. For example, a new teacher, a new school, or the beginning of the school year may require more assistance and therapist time for modeling, training, and sharing. As the accommodations and strategies become part of the everyday program, the support may change to more consultative sessions for planning and monitoring. If a new piece of equipment is needed or new challenge occurs, more direct therapy can be increased again. Teachers who have worked together with a therapist in adaptations and integrated therapy may not need as much consultation as a newer team member.

IEP Meetings

With integrated therapy, the IEP is a trans-disciplinary process allowing for goals and objectives to be written jointly and monitored across all settings. The IEP is not prepared ahead of time with separate sections for each related service. The IEP team works collaboratively to write all objectives, which address motor, language, mobility, sensory, or physical needs integrated throughout various subjects and settings. The IEP team uses an ecological assessment from a variety of sources, then prioritizes the needed interventions. The team uses discussion and consensus to make decisions.

The trans-disciplinary IEP present level of performance looks different than the traditional list of strengths and weaknesses. It emphasizes student strengths and support needs. It documents the types of supports and interventions that have been successful.

By planning together, teachers and therapists design open-ended activities, alternative communication or mobility goals, language opportunities, and support strategies which the educators then add to their repertoire for future use with many kinds of students.

Teachers, therapists, and paraprofessionals all work in various combinations to provide support in integrated therapy. Roles are expanded to incorporate co-teaching and a variety of collaborative styles. For example:

  • The OT shows the whole class an organizational strategy for note taking, which is not only useful for Patrice, a student with a learning disability, but for the entire class.

  • The teacher may facilitate cooperative groups, while the PT assures correct positioning of Raymond in a stander within his group. She answers student questions about the equipment, modeling awareness and understanding of disabilities for his peers.

  • The SLP is present during reading class to determine if Shevone's hearing impairment is impeding her participation and understanding, and whether she needs alternative support to benefit from the class.

  • The SLP co-teaches a social studies lesson with the teacher. They demonstrate steps for preparing and presenting an historical character report. Afterwards, in smaller groups, the SLP specifically guides and monitors two of her students as they plan for their oral character reports.

  • The PT observes Hun's class, noting physical barriers to some learning centers in the room.

  • The SLP observes during a class social activity to assess frequency and effectiveness of Celina's social skills with initiating conversations with peers and requesting assistance or more information.

  • Between visits, the therapists and teachers can use a communication log to discuss concerns and ask questions. The educators share ideas and record attempted interventions and results. The log is initialed at each session. While this log should never replace discussion and physical meetings, it can bridge disciplines, eliminating the frequently ineffective "questions on the fly" (in the workroom, hall, or even during class instruction time).

References:

Craig, S., & Haggart, A. (1994). Integrated therapies. Hampton NH: AGH Associates.

Giangreco, M. (1996). Vermont interdependent services team approach (VISTA): A guide to coordinating educational support services Baltimore MD: Paul H Brookes.

Orelove, F., & Sobsey, D. (1996). Educating children with multiple disabilities: A trans-disciplinary approach (3rd edition). Baltimore MD: Paul H. Brookes.

Rainforth, B., & York-Barr, J. (1997). Collaborative teams for students with severe disabilities: Integrated therapy and educational services (2nd edition). Baltimore MD: Paul H. Brookes.

Date: May/June 1998